Making Health Equity a Priority When Hospitals Propose Mergers
Lois Uttley
Women’s Health Program Director, Community Catalyst
Rampant hospital consolidation is threatening access to comprehensive reproductive health services and LGBTQ-inclusive care across the United States. This is especially true when secular community hospitals are merging with giant national Catholic health systems that have prohibitions on the delivery of services such as abortions, contraception, sterilizations, infertility treatments, safer sex counseling, and LGBTQ-inclusive care such as gender-affirming surgery. Typically, community hospitals are required to adopt these restrictive policies as a condition of mergers with Catholic health systems.
The patients most affected by these losses of health care services are women and LGBTQ people — especially those who are Black, Latinx, immigrants, uninsured, people with disabilities, rural residents, and others who are medically underserved. These patients have the least ability to travel elsewhere for care that becomes prohibited at their local hospitals. People living in 52 communities around the nation have only a hospital that uses such non-medical policy-based restrictions on care.
Recently, health care policy analysts, advocates and policymakers have begun to look at this situation as part of a bigger health equity problem being created by hospital consolidation. Decades of downsizing and closings of urban safety net hospitals and the loss of dozens of rural hospitals in recent years meant there was not enough hospital inpatient capacity to handle the surge of COVID-19 patients who have been disproportionately Black and Latinx. Moreover, closures of hospital maternity units, especially in rural areas, have forced pregnant people to travel long distances for labor and delivery services.
Two state legislatures took action this year to ensure that health equity is a consideration when state regulators consider proposed hospital mergers, downsizing, and closings:
In New York, Gov. Kathy Hochul signed into law S1451A, which adds a requirement for an independent health equity assessment to the state Certificate of Need process through which regulators consider proposed health facility transactions. The assessments will determine the likely impact of a proposed merger on women, LGBTQ people, people of color, people with low incomes, and other medically underserved groups. The assessment process must include engagement with the affected community, and the final assessment document will have to be posted on the website of the NYS Department of Health, where community members will be able to read it and submit comments. Advocates are planning to engage with the new state health commissioner Dr. Mary Bassett, a recognized authority on health equity, to implement this newly passed legislation.
In Oregon, H.B. 2362 was just signed into law on September 25 by Gov. Kate Brown. This measure gives the Oregon Health Authority jurisdiction over large-size proposed mergers, acquisitions, and affiliations. The authority could deny approval if the applicants can’t show that the transaction would increase access to services in medically underserved areas, improve health outcomes, or reduce patient costs. Transactions that would cause a loss of “essential services,” which are enumerated on a list previously issued by the state, would receive special scrutiny. The long list of services includes treatment for pregnancy, maternity care, termination of pregnancy, ectopic pregnancy, and other key reproductive health services.
There is also potential for action at the federal level, where President Joe Biden’s Executive Order on industry consolidation is prompting examination of the impact of health industry consolidation on access to services, as well as price. Biden said hospital mergers “left many areas, especially rural communities, without good options for convenient and affordable health care service.” That order followed a Biden administration request for suggestions on how to ensure health equity is included in all government policies, programs, services, processes, and operations.